Search

Objective: To determine the accuracy of high‐risk human papillomavirus (HPV) DNA samples on filter paper in comparison to specimen transport medium (STM). Methods: This was a cross‐sectional diagnostic study of 42 consecutive women who were prospectively recruited. Each had self‐collected vaginal samples on filter paper, physician‐collected cervical samples on filter paper, and physician‐collected cervical samples in STM. HPV DNA testing was performed with a Hybrid Capture 2 system (Qiagen). Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and agreement of filter paper methods with the standard procedure were calculated. Results: The overall prevalence of HPV in STM was 67.5%. Detection of HPV DNA in the physician‐collected cervical samples on filter paper had a sensitivity of 77.8%, a specificity of 100%, a PPV of 100%, and an NPV of 68.4%. The patient's self‐sampling on filter paper had a sensitivity of 66.7%, a specificity of 100%, a PPV of 100%, and an NPV of 59.1%. The agreement between STM method and physician‐collected sample on filter paper was substantial, (κ = 0.695, P < 0.001), while the agreement between STM and self‐collected samples on filter paper was moderate (κ = 0.565, P < 0.001). Most patients reported that self‐collection was acceptable (100%), painless (95%), and not embarrassing (95%). Conclusion: Filter paper, with dried self‐collected vaginal samples, can be used to detect high‐risk HPV with acceptable accuracy. Synopsis: Self‐collected vaginal samples on filter paper, to detect high‐risk human papillomavirus, is better for women, easier to transport to central laboratories, and has acceptable accuracy. [ABSTRACT FROM AUTHOR]

Menopause marks the end of menstrual cyclicity and, depending on individual vulnerability, has several consequences related to gonadal steroid deprivation, especially if it is premature. Menopause may be more burdensome for some women than for others. Individual factors, such as personal history, socioeconomic status, ethnicity, and current health conditions, affect symptomatology and, thereby, the menopausal experience. In addition, some menopausal symptoms, such as severe hot flashes, sleep disorders, and depression, are markers of future health risks. Counseling is a fundamental part of health care in the peri‐ and postmenopause periods. It must include an assessment of the patient's symptoms, needs, desires, and risk profile to address the benefits and risks of menopausal hormone therapy (MHT) on an individual basis and promote a healthy lifestyle. Indeed, healthcare practitioners can and must protect the health and lives of mid‐life women by increasing awareness of menopausal symptoms and ensuring healthcare options, especially MHT. The type and duration of MHT should be tailored based on the patient's history, menopausal age, physical characteristics, and current health status so that the benefits always outweigh the risks. This FIGO position paper focuses on the benefits and risks of MHT on health domains, target organs, and systems, and on systemic and vaginal MHT regimens, to provide indications that can be used in the clinical practice for menopausal counseling. Moreover, it offers insights into what FIGO considers the mainstay for the healthcare management of women in peri‐ and postmenopause, worldwide. Synopsis: The increase in life expectancy has made post‐reproductive health a global priority. Counseling on the benefits and risks of menopausal hormone therapy and lifestyle education is fundamental. [ABSTRACT FROM AUTHOR]

Cesarean delivery rates are rapidly increasing in Southeastern Europe (to more than 60%), North Africa (with a rate as high as 72% in Egypt), and in urban areas in Southern Africa (a rate of over 50% in Lagos, Nigeria). Data on the background to these increases are scarce, but likely to include poor birthing facilities in general hospitals, convenience for the doctor, private medicine, fear of litigation, socioeconomic status, shortage of midwives and nurses, and disappearance of vaginal instrumental deliveries. Options to reverse cesarean delivery trends are discussed. In this context there is a need to be better informed about how women are being counseled regarding vaginal or cesarean delivery. The long-term consequences in subsequent pregnancies for mothers and children may well be largely ignored, while these risks are highest in LMICs where higher birth numbers are desired. FIGO has begun discussions with obstetric and gynecologic societies, healthcare bodies, and governments in several countries discussed in this article, to find ways to lower the cesarean delivery rate. The requests came from the countries themselves, which may prove beneficial in helping advance progress. [ABSTRACT FROM AUTHOR]

Cesarean delivery rates are rapidly increasing in Southeastern Europe (to more than 60%), North Africa (with a rate as high as 72% in Egypt), and in urban areas in Southern Africa (a rate of over 50% in Lagos, Nigeria). Data on the background to these increases are scarce, but likely to include poor birthing facilities in general hospitals, convenience for the doctor, private medicine, fear of litigation, socioeconomic status, shortage of midwives and nurses, and disappearance of vaginal instrumental deliveries. Options to reverse cesarean delivery trends are discussed. In this context there is a need to be better informed about how women are being counseled regarding vaginal or cesarean delivery. The long‐term consequences in subsequent pregnancies for mothers and children may well be largely ignored, while these risks are highest in LMICs where higher birth numbers are desired. FIGO has begun discussions with obstetric and gynecologic societies, healthcare bodies, and governments in several countries discussed in this article, to find ways to lower the cesarean delivery rate. The requests came from the countries themselves, which may prove beneficial in helping advance progress. Synopsis: Cesarean delivery rates are rapidly increasing in southeastern Europe, North Africa, and in urban areas in Southern Africa, prompting a time for reflection. [ABSTRACT FROM AUTHOR]

The article discusses the need for improvement in the peer review system for evaluating submitted manuscripts. The authors propose a new system to track the outcomes of rejected manuscripts, allowing for a better understanding of their "fates." They suggest that authors should report to the journal that finally accepted their manuscript where it was previously rejected. This system aims to increase transparency in the academic publication world and improve the evaluation skills of reviewers, editors, and journals. [Extracted from the article]

The International Journal of Gynecology & Obstetrics has announced the winner of the John J. Sciarra IJGO Prize Paper Award for 2023. The winning paper, titled "Efficacy of combination of transcervical Foley catheter and sublingual misoprostol versus sublingual misoprostol for labor induction in pre‐eclampsia at 28–34 weeks," compares different methods of labor induction for women with pre-eclampsia. The study found that the combination approach achieved higher rates of vaginal birth within 24 hours compared to using misoprostol alone, with similar neonatal outcomes. This research highlights the importance of finding effective labor induction methods to reduce maternal and perinatal morbidity and mortality, particularly in low- and middle-income countries. The article also mentions other papers that received honorable mentions for their contributions to clinical research in the field of gynecology and obstetrics. The IJGO Prize Paper Award aims to encourage investigators from low- and middle-income countries to submit their best clinical research articles for publication. [Extracted from the article]

The International Journal of Gynecology and Obstetrics (IJGO) has announced a prize award for the best clinical research paper from a low- or middle-income country published in the journal during 2024. All clinical research articles from low- and middle-income countries published in 2024 will be considered for the prize, which includes an £800 stipend, a certificate of recognition, and complimentary access to the online version of IJGO for one year. The award aims to encourage investigators, especially young scientists, from low- and middle-income countries to submit their best clinical research articles for publication in IJGO. The journal is the official publication of the International Federation of Gynecology and Obstetrics (FIGO), which is dedicated to enhancing women's healthcare worldwide and emphasizes important obstetric and gynecologic problems, issues, and perspectives, such as maternal mortality and family planning. [Extracted from the article]

The International Journal of Gynecology & Obstetrics (IJGO) has announced the John J. Sciarra Prize Paper Award for 2024. This award is given to the best clinical research paper from a low- or middle-income country published in the IJGO during 2024. The winning corresponding author will receive an £800 stipend, a certificate of recognition, and complimentary access to the online version of IJGO for one year. The purpose of this award is to encourage investigators, especially young scientists, from low- and middle-income countries to submit their best clinical research articles for publication in IJGO. The IJGO is the official publication of the International Federation of Gynecology and Obstetrics (FIGO), which aims to enhance women's healthcare worldwide by publishing original scientific articles and communications from low-income countries, focusing on important obstetric and gynecologic problems, issues, and perspectives. [Extracted from the article]

Publication of the Intergrowth‐21st and WHO growth charts raises the question of which growth data prenatal providers should use in clinical practice. Is it better to use a universal chart applied globally, or metrics based on local or regional growth patterns? And what about customized charts versus local charts? FIGO has reviewed the different growth charts and studies assessing their reproducibility and predictive values for small‐ and large‐for‐gestational age newborns and, where available, adverse fetal outcomes. It concludes that local or regional charts are likely to be best for identifying the 10th percentile of newborns at highest risk. However, international standards for growth may also be used when coupled with locally appropriate thresholds for risk interpretation. Local fetal growth charts better identify fetuses at highest risk. Global charts may be used, but with a locally appropriate threshold for risk interpretation. [ABSTRACT FROM AUTHOR]

The International Journal of Gynecology & Obstetrics (IJGO) has announced the John J. Sciarra Prize Paper Award for 2024. This award is given to the best clinical research paper from a low- or middle-income country published in the IJGO during 2024. The winning corresponding author will receive an £800 stipend, a certificate of recognition, and complimentary access to the online version of IJGO for one year. The purpose of this award is to encourage investigators, especially young scientists, from low- and middle-income countries to submit their best clinical research articles for publication in IJGO. The IJGO is the official publication of the International Federation of Gynecology and Obstetrics (FIGO), which aims to enhance women's healthcare worldwide by publishing original scientific articles and communications from low-income countries, focusing on important obstetric and gynecologic problems, issues, and perspectives. [Extracted from the article]

The endometrium undergoes cyclical changes in response to hormones and there is a certain degree of heterogeneity among individuals. In vivo identification of the physiologic changes of the endometrium and the pathologic process of related diseases is challenging. There have been recent advances in the use of organoids that mimic the characteristics of the corresponding organs and the morphologic, functional, and personalized characteristics involved in different stages of diseases. In this paper, we discuss the process of creating endometrial organoids, cell sources, types of extracellular matrices, and their application in the study of physiologic endometrial states and various diseases. Synopsis: The paper explores endometrial organoids, their use in studying physiologic states and diseases, and recent advancements in this field. [ABSTRACT FROM AUTHOR]

Through a process of shortlisting and voting, FIGO's Scientific Programme Committee selected these as outstanding abstracts from the full range of abstracts presented at the FIGO World Congress. Although early abstract submissions for the World Congress have closed, authors will have another opportunity to submit to the Congress when late-breaking abstract submissions open in April 2023. FIGO's 24th World Congress is fast approaching - this will be held at the Paris Convention Centre in Paris, France, on 9-13 October 2023, for what will be the first-ever hybrid FIGO World Congress. [Extracted from the article]

Abstract: Objective: To detect the presence of male DNA in vaginal samples collected from survivors of sexual violence and stored on filter paper. Methods: A pilot study was conducted to evaluate 10 vaginal samples spotted on sterile filter paper: 6 collected at random in April 2009 and 4 in October 2010. Time between sexual assault and sample collection was 4–48hours. After drying at room temperature, the samples were placed in a sterile envelope and stored for 2–3years until processing. DNA extraction was confirmed by polymerase chain reaction for human β-globin, and the presence of prostate-specific antigen (PSA) was quantified. The presence of the Y chromosome was detected using primers for sequences in the TSPY (Y7/Y8 and DYS14) and SRY genes. Results: β-Globin was detected in all 10 samples, while 2 samples were positive for PSA. Half of the samples amplified the Y7/Y8 and DYS14 sequences of the TSPY gene and 30% amplified the SRY gene sequence of the Y chromosome. Four male samples and 1 female sample served as controls. Conclusion: Filter-paper spots stored for periods of up to 3years proved adequate for preserving genetic material from vaginal samples collected following sexual violence. [Copyright &y& Elsevier]

Background: Obstetric fistula develops from obstructed labor and is a devastating condition with significant consequences across several domains of a woman's life. This study presents a narrative review of the evidence on the economic consequences of obstetric fistula. Methods: Three databases were searched, and search results were limited to English language papers published after 2003. Search results were reviewed for relevance based on title and abstract followed by full text review using specific inclusion and exclusion criteria. Bibliographies of papers were also scanned to identify relevant papers for inclusion. Data were extracted under three categories (defined a priori): the economic consequences of having the condition, the economic consequences of seeking care, and the macroeconomic impacts. Results: The search returned 517 unique papers, 49 of which were included after screening. Main findings identified from the studies include women losing their jobs, becoming dependent on others, and losing financial support when relationships are lost. Seeking care was economically costly for families or unaffordable entirely. There were no studies describing the impact of fistula on national economies. Conclusion: Economic consequences of obstetric fistula are multifaceted, pervasive, and are intertwined with the physical and psychosocial consequences of the condition. Understanding these consequences can help tailor existing fistula programs to better address the impacts of the condition. Further research to address the dearth of literature describing the macroeconomic impact of obstetric fistula will be critical to enhance the visibility of this condition on the health agendas of countries. Synopsis: Women experiencing obstetric fistula lose income, become financially dependent on others, and face economic barriers and hardships when seeking care for the condition. [ABSTRACT FROM AUTHOR]

This good clinical practice paper provides an overview of the current evidence around second stage care, highlighting the challenges and the importance of maintaining high-quality, safe, and respectful care in all settings. It includes a series of recommendations based on best available evidence regarding length of second stage, judicious use of episiotomy, and the importance of competent attendants and adequate resource to facilitate all aspects of second stage management, from physiological birth to assisted vaginal delivery and cesarean at full dilatation. The second stage of labor is potentially the most dangerous time for the baby and can have significant consequences for the mother, including death or severe perineal trauma or fistula, especially where there are failures to recognize and repair. This paper sets out principles of care, including the vital role of skilled birth attendants and birth companions, and the importance of obstetricians and midwives working together effectively and speaking with one voice, whether to women or to policy makers. The optimization of high-quality, safe, and personalized care in the second stage of labor for all women globally can only be achieved by appropriate attention to the training of birth attendants, midwives, and obstetricians. FIGO is committed to this aim alongside the WHO, ICM, and all FIGO's 132 member societies. [ABSTRACT FROM AUTHOR]

With the increase in obesity prevalence among women of reproductive age globally, the risks of type 2 diabetes, gestational diabetes, pre-eclampsia, and other conditions are rising, with detrimental effects on maternal and newborn health. The period before pregnancy is increasingly recognized as crucial for addressing weight management and reducing malnutrition (both under- and overnutrition) in both parents to reduce the risk of noncommunicable diseases (NCDs) in the mother as well as the passage of risk to her offspring. Healthcare practitioners, including obstetricians, gynecologists, midwives, and general practitioners, have an important role to play in supporting women in planning a pregnancy and achieving healthy nutrition and weight before pregnancy. In this position paper, the FIGO Pregnancy Obesity and Nutrition Initiative provides an overview of the evidence for preconception clinical guidelines to reduce the risk of NCDs in mothers and their offspring. It encourages healthcare practitioners to initiate a dialogue on women's health, nutrition, and weight management before conception. While acknowledging the fundamental importance of the wider social and environmental determinants of health, this paper focuses on a simple set of recommendations for clinical practice that can be used even in short consultations. The recommendations can be contextualized based on local cultural and dietary practices as part of a system-wide public health approach to influence the wider determinants as well as individual factors influencing preconception health. [ABSTRACT FROM AUTHOR]

Objective: Noninvasive prenatal testing (NIPT) has increased the number of conditions that can be screened. However, the prevalence of conditions assessed by NIPT has remained stable. The "prevalence threshold," a novel epidemiological concept, uses a test's sensitivity and specificity to determine the prevalence below which a test's positive predictive value declines most sharply relative to disease prevalence. In this article, we calculated the prevalence threshold for common conditions assessed through NIPT and compared the value with the actual prevalence of each condition to best ascertain the reliability of NIPT results. Methods: Six databases and PubMed were searched from January 2010 to March 2023 for sensitivity and specificity parameters of common conditions tested through NIPT. Using an equation previously derived by the authors of the current paper, the prevalence threshold for each condition was calculated. The theoretical number of test iterations required to reach the prevalence threshold was also reported. Results: None of the conditions tested through the NIPT had a prevalence rate that met or exceeded the calculated prevalence threshold. Trisomy 21 had the greatest concordance between the prevalence rate and the prevalence threshold. In contrast, Angelman, Cri‐du‐chat, and Prader‐Willi syndromes had the most significant discordance. Apart from trisomy 21 and XXY, all remaining conditions required more than one test iteration to reach their respective prevalence threshold. Conclusion: We conclude that at the current prevalence levels, the positive predictive value of NIPT remains low, with the prevalence of disease levels significantly lower than the prevalence threshold for each condition tested. Synopsis: The positive predictive value of noninvasive prenatal testing remains low, with the prevalence of disease levels significantly lower than the prevalence threshold for each condition tested. [ABSTRACT FROM AUTHOR]

Despite efforts to reduce stillbirths and neonatal deaths, inconsistent definitions and reporting practices continue to hamper global progress. Existing data frequently being limited in terms of quality and comparability across countries. This paper addresses this critical issue by outlining the new International Classification of Disease (ICD‐11) recommendations for standardized recording and reporting of perinatal deaths to improve data accuracy and international comparison. Key advancements in ICD‐11 include using gestational age as the primary threshold to for reporting, clearer guidance on measurement and recording of gestational age, and reporting mortality rates by gestational age subgroups to enable country comparisons to include similar populations (e.g., all births from 154 days [22+0 weeks] or from 196 days [28+0 weeks]). Furthermore, the revised ICD‐11 guidance provides further clarification around the exclusion of terminations of pregnancy (induced abortions) from perinatal mortality statistics. Implementing standardized recording and reporting methods laid out in ICD‐11 will be crucial for accurate global data on stillbirths and perinatal deaths. Such high‐quality data would both allow appropriate regional and international comparisons to be made and serve as a resource to improve clinical practice and epidemiological and health surveillance, enabling focusing of limited programmatic and research funds towards ending preventable deaths and improving outcomes for every woman and every baby, everywhere. [ABSTRACT FROM AUTHOR]

Background: Hysteroscopy represents the gold standard for the diagnosis and treatment of intrauterine pathologies. The advent of the mini‐resectoscope heralded a new era in intrauterine surgery, both in inpatient and outpatient settings. Objectives: To evaluate the effectiveness, safety, and feasibility of the mini‐resectoscope for the treatment of intrauterine pathologies. Search Strategy: Electronic databases were searched for English‐language trials describing surgical procedures for uterine pathologies performed with a mini‐resectoscope until 30 April 2023. Selection Criteria: Retrospective or prospective original studies reporting the treatment of uterine pathologies with mini‐resectoscope were deemed eligible for the inclusion. Data Collection and Analysis: Data about study features, characteristics of included populations, surgical procedures, complications, and results/outcomes were collected. Results: Seven papers that met the inclusion criteria were included in this systematic review. Quantitative analysis was not possible due to data heterogeneity. A descriptive synthesis of the results was provided accordingly to the pathology hysteroscopically removed/corrected: polyps and myomas, uterine septum, intrauterine synechiae, and isthmocele. Conclusions: The mini‐resectoscope is poised to play a leading role in hysteroscopic surgery for many pathologies, both in inpatient and outpatient settings. Since some applications of the mini‐resectoscope have not yet been thoroughly investigated, future studies should address current knowledge gaps, designing high‐quality comparative trials on specific applications. Synopsis: The mini‐resectoscope is an effective and versatile instrument for treating intrauterine pathologies both in inpatient and outpatient settings. [ABSTRACT FROM AUTHOR]

Adenomyosis is an intricate pathological condition that negatively impacts the uterus. It is closely related to the more well‐known endometriosis, with which it shares parallels in terms of diagnosis, therapy, and both microscopic and macroscopic features. The purpose of this narrative review is to give a clear univocal definition and outlook on the different, patient‐adapted, surgical treatments. MEDLINE and PubMed searches on these topics were conducted from 1990 to 2022 using a mix of selected keywords. Papers and articles were identified and included in this narrative review after authors' revision and evaluation. From the literature analysis, authors reported the following surgical techniques: laparoscopic double/triple‐flap method, laparotomic wedge resection of the uterine wall, laparotomic transverse H‐incision of the uterine wall, laparotomic wedge‐shaped excision, and laparotomic complete debulking excision by asymmetric dissection technique. Each of these techniques has strengths and weaknesses, but the literature data on the pregnancy rate are somewhat limited. The only certain information is the risk of uterine rupture up to 6.0% after surgical treatment for uterine adenomyosis. Over the years, the surgical approach continued to reach a positive result by minimally invasive treatment, with less hospitalization, less postoperative pain, and less blood loss. Over the years, the gynecological surgeon has gained the skills, training and increasingly sophisticated surgical techniques to target effective therapy. That's why a hysterectomy is no longer the only surgical resource to treat adenomyosis, but in patients who wish to preserve the fertility, there is a wide variety of surgical alternatives. Synopsis: This research summarizes the laparoscopic and laparotomic fertility‐sparing treatments for adenomyosis and adenomyoma, two complex entities, which are difficult to approach surgically due to the subsequent possible sequelae. [ABSTRACT FROM AUTHOR]

This award has been established for the purpose of encouraging investigators, especially young scientists, from low- and middle-income countries to submit their very best clinical research articles for publication in IJGO. IJGO is the official publication of the International Federation of Gynecology and Obstetrics (FIGO), the primary international organization for the specialty of obstetrics and gynecology. The editors of the I International Journal of Gynecology and Obstetrics i (IJGO) are pleased to announce a prize award for the best clinical research paper from a low- or middle-income country published in the IJGO during 2022. [Extracted from the article]

Background: Counseling as part of the informed consent process is a prerequisite for cesarean section (CS). Postnatal debriefing allows women to explore their CS with their healthcare providers (HCPs). Objectives: To describe the practices and experiences of counseling and debriefing, the barriers and facilitators to informed consent for CS; and to document the effectiveness of the interventions used to improve informed consent found in the peer‐reviewed literature. Search Strategy: The databases searched were PubMed, EMBASE, PsycINFO, Africa‐wide information, African Index Medicus, IMSEAR and LILACS. Selection Criteria: English‐language papers focusing on consent for CS, published between 2011 and 2022, and assessed to be of medium to high quality were included. Data Collection and Analysis: A narrative synthesis was conducted using Beauchamp and Childress's elements of informed consent as a framework. Main Results: Among the 21 included studies reporting on consent for CS, 12 papers reported on counseling for CS, while only one reported on debriefing. Barriers were identified at the service, woman, provider, and societal levels. Facilitators all operated at the provider level and interventions operated at the service or provider levels. Conclusions: There is a paucity of research on informed consent, counseling, and debriefing for CS in sub‐Saharan Africa. Synopsis: This scoping review identified only a small number of peer‐reviewed papers on informed consent, counseling, and debriefing for cesarean section in sub‐Saharan Africa. [ABSTRACT FROM AUTHOR]

The Maputo Protocol, adopted over 20 years ago, is a promising regional treaty for advancing gender equity and sexual and reproductive health and rights. This instrument has driven progress in women's health and rights across Africa, with much remaining to achieve to realize its full potential for women and girls, including access to safe abortion. The present paper shares the strategies and lessons from the Democratic Republic of Congo's (DRC) reform centered on the domestication of the Protocol, specifically applying its commitments on abortion decriminalization and access. With a vision of addressing maternal mortality and rectifying the impacts of widespread sexual violence against women during war, abortion as a human right and health imperative was at the heart of the DRC's reform. Governmental commitment, broad coalition building, evidence generation, and an intersectional advocacy agenda were critical to overcoming opposition, stigma, and other challenges. This paper shares key learnings from the DRC's complex yet collaborative reform strategies and its processes. The strategy prioritized domestication of the Protocol for numerous reforms, including paving the path to legal abortion on the broad grounds of rape or incest, and saving women's health and/or life. With a commitment to maximizing quality, access, task sharing, and equity, progressive national comprehensive abortion guidelines were created alongside an implementation roadmap for accountability. The DRC's experience leveraging the Maputo Protocol's obligations to advance abortion rights and access offers valuable insights for consideration globally. Synopsis: The Maputo Protocol is a groundbreaking treaty for advancing women's rights, including abortion access in the DRC and potentially elsewhere in Africa. [ABSTRACT FROM AUTHOR]

Background: Mycoplasma genitalium is an emerging pathogen, which has been linked to cervicitis, urethritis and pelvic inflammatory disease (PID). With the advent of multiplex polymerase chain reaction (PCR) panels for sexually transmitted infections, it is increasingly being identified in pregnant women. Objectives: The aim was to review international guidelines, which had explicit recommendations for treatment of M. genitalium infection in pregnancy and breastfeeding. Search Strategy: PubMed, EMBASE and Cochrane databases were reviewed with no age, species, language or date restrictions. Selection Criteria: Studies were included if they had an explicit recommendation for treatment of M. genitalium in pregnancy. Studies were excluded if there was no recommendation in pregnancy, if they referred to other international guideline recommendations or were historical versions of guidelines. Data Collection and Analysis: References were manually reviewed and 50 papers were selected for review. Only four guidelines were included in the final analysis and they were from Europe, UK, Australia and Aotearoa New Zealand. Main Results: All studies recommended azithromycin as first‐line treatment, and advised against moxifloxacin use. The dosing schedule of azithromycin, varied between guidelines, as did the utility/safety of pristinamycin for macrolide resistant infections. Safety data was generally reassuring for azithromycin but inconsistent for pristinamycin. Conclusions: Azithromycin is the first‐line treatment for macrolide susceptible or unknown resistance infections, but there is a lack of consistency regarding dosing of azithromycin or the utility/safety of pristinamycin for macrolide resistant infections in pregnancy/lactation. Synopsis: While international guidelines recommend azithromycin as first‐line treatment for M. genitalium infections in pregnancy, there are inconsistencies around second‐line treatment options and azithromycin dosing. [ABSTRACT FROM AUTHOR]

At present, prenatal ultrasound is one of the important means for screening fetal malformations. In the process of prenatal ultrasound diagnosis, the accurate recognition of fetal facial ultrasound standard plane is crucial for facial malformation detection and disease screening. Due to the dense distribution of fetal facial images, no obvious structure contour boundary, small structure area, and large area overlap in the middle of the structure detection frame, this paper regards the fetal facial standard plane and its structure recognition as a universal target detection task for the first time, and applies real‐time YOLO v5s to the fetal facial ultrasound standard plane structure detection and classification task. First, we detect the structure of a single slice, and take the structure of a slice class as the recognition object. Second, we carry out structural detection experiments on three standard planes; then, on the basis of the previous stage, the images of all parts included in the ultrasound examination of multiple fetuses were collected. In the single‐class structure detection experiment and the structure detection and classification experiment of three types of standard planes, the overall recognition effect of Precision and Recall index data is better, with Precision being 98.3% and 98.1%, and Recall being 99.3% and 98.2%, respectively. The experimental results show that the model has the ability to identify fetal facial anatomy and standard sections in different data, which can help the physician to automatically and quickly screen out the standard sections of each fetal facial ultrasound. Synopsis: By automatically identifying key anatomical structures within ultrasound images, it provides a theoretical basis for doctors to choose standard planes. [ABSTRACT FROM AUTHOR]

Background Objectives Search Strategy Selection Criteria Data Collection and Analysis Main Results Conclusions Recent recommendations from the French High Authority of Health on pelvic organ prolapse (POP) management underline the value of a pelvic examination.The aim of this paper was to analyze the literature and identify the best evidence available regarding pelvic examination for women presenting prolapse‐associated symptoms in terms of diagnosis and predictability of treatment success.The databases were queried similarly using Medical Subject Headings (MeSH) and non‐MeSH terms broadly related to pelvic examination and POP management.We included studies assessing the diagnostic contribution of pelvic examination (correlation with symptoms) and its value for assessing the risk of pessary failure or recurrence after reconstructive surgery.We assessed peer‐reviewed articles on PubMed, Embase, and Cochrane database up to May 2023. The methodological quality of all the included studies was assessed using the ROBINS‐E or RoB2 tools.In all, 67 studies were retained for the review. Prolapse‐associated symptoms are poorly correlated with POP diagnosis. The symptom that is best correlated with the POP stage is the presence of a vaginal bulge (moderate to good correlation). The factors most strongly associated with the risk of recurrence after surgery or pessary failure are clinical: essentially a higher POP stage before surgery, levator ani muscle avulsion, and vaginal and genital measurements.In women complaining of prolapse‐associated symptoms, a pelvic examination (vaginal speculum and digital vaginal examination) can confirm the presence of POP and identify risk factors for treatment failure or recurrence after surgical management or pessary placement. A higher stage of POP and levator ani muscle avulsion—discernible on pelvic examination—are major risk factors for POP recurrence or treatment failure. These features must be taken into account in the treatment choice and discussed with the patient. [ABSTRACT FROM AUTHOR]

Objective: Endometriosis affects approximately 10% of women of reproductive age and leads to significant morbidity and financial burden. Consequently, countries such as France and Germany are formulating strategies to combat endometriosis. In this study, we propose the implementation of our three‐dimensional model (3D‐E) to raise awareness about endometriosis and enhance timely diagnosis, treatment, and long‐term care for affected patients. Methods: Based on the adapted Six Sigma Principle and the modified recommendation of Sales et al. for implementing evidence‐based findings into a clinical routine, we first conducted a comprehensive investigation to identify risk factors leading to diagnostic delay of endometriosis. After identifying improvable factors, the applicable options were selected due to defined criteria such as integrability in the clinical routine, cost‐effectiveness, and evidence‐based‐principle. Finally, solutions feasible for health care providers were integrated and the 3D‐E model was established. Results: Some of the main risk factors contributing to diagnostic delays are symptoms acceptance and misinterpreted symptoms, especially if presenting to nongynecologists in cases of extragenital endometriosis with atypical presentation. Therefore, we tried to sensitize colleagues (first dimension) with a review paper in Germany's largest medical journal and started an elective for medical students (second dimension) at our university. In order to involve additional health care professionals in endometriosis care (third dimension), we are preparing the concept of the EndoNurse. Conclusion: The 3D‐E model is a relatively low‐cost, comprehensive, and worldwide adaptable approach for facilitating knowledge transfer, sensitizing health care providers, and improving endometriosis diagnostics and therapy for patients with endometriosis who are in the center of the model. Synopsis: The 3D‐E model could have the potential to be a first step to improve endometriosis awareness and care. [ABSTRACT FROM AUTHOR]

This paper argues that the current abortion regulation by Law 194/1978 is an inadequate basis for the provision of good quality abortion care and must be reformed. First, the paper explains why Law 194/1978 creates a hyper‐regulatory regime that is inconsistent with the best clinical evidence and practices in the field as well as relevant international human rights law, as outlined in the World Health Organization's (WHO) 2022 Abortion Care Guideline. Second, it highlights gaps between what the law says and what happens in practice, pointing out how the everyday life of Law 194/1978, especially in the practices of gynecologists, is far removed from international standards of quality abortion care and has yet to comply with international human rights law. Third, it sets out some alternative routes to abortion access "outside" Law 194/1978. Finally, it concludes with some suggestions for a change in the practice of gynecology and a call for the reform of Law 194/1978, in favor of a bodily autonomy model of regulation grounded on decriminalization, demedicalization, dehospitalization, and self‐management to ensure compliance with the WHO standards and international human rights law. Synopsis: The paper evaluates the inconsistencies of current abortion regulation and clinical practice in Italy against the 2022 WHO Abortion Care Guideline. [ABSTRACT FROM AUTHOR]

Background: Recurrent pregnancy loss is defined as the loss of two or more pregnancies and is a distressing condition for couples. Objective: To investigate the relationship between variants in the candidate susceptibility genes and epigenetic factors to identify risk factors for idiopathic recurrent pregnancy loss (iRPL). Search Strategy: A systematic literature search was performed using PubMed, Google Scholar, ScienceDirect, and Scopus databases. Insilico analysis was carried out using ShinyGO and STRING software. Selection Criteria: Research papers examining the association between variations in genetic and epigenetic factors and iRPL. Data Collection and Analysis: Data were independently extracted by two authors. Main Results: In total, 83 research papers were finally selected for the present study. Among all the genes involved in the pathogenesis of recurrent pregnancy loss, polymorphisms in IL superfamily genes, VEGF, ESR, and MTHFR were the most investigated. Conclusion: Polymorphisms in angiogenesis, immune tolerance, and thrombophilia pathway genes, which occur independently or synergistically, may lead to various complications during fetal development. Identification of multi‐allele risk variants and epigenetic factors in women will be helpful in the identification of high‐risk pregnancies. Prospero Registration Number: Prospero CRD42021287315. Synopsis: Investigation of maternal genetic/epigenetic risk factors for idiopathic recurrent pregnancy loss could help to identify high‐risk pregnancies, and couples could be counseled and managed accordingly. [ABSTRACT FROM AUTHOR]

In September 2021, the Mexican Supreme Court issued a decision disallowing any federal or local judicial authority to indict someone for the offense of voluntary or consensual abortion. This decision also declared unconstitutional penalties imposed on medical personnel who facilitate or assist such procedures. Furthermore, the Court decided that limiting access to abortion in cases of rape to a specific time frame was disproportionate. Later on, in September 2023, the Supreme Court confirmed that absolute criminalization of abortion was unconstitutional and declared that the rule supporting criminalization in the Federal Penal Code was without effects. Consequently, healthcare providers who work in public federal health institutions cannot be criminalized for guaranteeing the right to abortion. This article reviews the reasons advanced by the Supreme Court to guarantee the right of reproductive self‐determination, as well as the effects of both decisions beyond the decriminalization of abortion by Mexican federal and state legislatures. The paper also examines the scope and limitations of these rulings and identifies the remaining challenges regarding voluntary abortion procedures in Mexico. Synopsis: This article reviews how the Mexican Supreme Court decriminalized abortion in 2021 and 2023 and the effects of the decisions for promoting reproductive health care and self‐determination. [ABSTRACT FROM AUTHOR]

Umbilical cord cysts (UCCs)—cysts located in the umbilical cord that are derived from an abnormal embryonic development process—are typically an incidental discovery during prenatal ultrasound. It can be described as either a pseudocyst or a true UCC, which results from focal edema or degeneration of Wharton jelly or the remnants of embryonic development, respectively. Due to the relative rarity of the UCC, the clinical guidance of UCCs is not yet available. Herein, the aim of this paper is to discuss the classification, diagnosis, prognosis, and clinical management of UCCs through a literature review, in order to improve the understanding of UCCs among clinical obstetricians and pediatricians. Synopsis: The classification, diagnosis, prognosis, and clinical management of UCC. [ABSTRACT FROM AUTHOR]

Objective: To explore the management and experiences of healthcare providers around anesthetic care in placenta accreta spectrum (PAS). Methods: This descriptive survey study was carried out over a 6‐week period between January and March 2023. Healthcare providers, both anesthesiologists and those involved in operative care for women with PAS, were invited to participate. Questions invited both quantitative and qualitative responses. Qualitative responses were analyzed using content analysis. Results: In all, 171 healthcare providers responded to the survey, the majority of whom were working in tertiary PAS referral centers (153; 89%) and 116 (70%) had more than 10 years of clinical experience. There was variation in the preferred primary mode of anesthesia for PAS cases; 69 (42%) used neuraxial only, but 58 (35%) used a combined approach of neuraxial and general anesthesia, with only 12 (8%) preferring general anesthesia. Ninety‐nine (61%) were offering a routine antenatal anesthesia consultation. Content analysis of qualitative data identified three main themes, which were "variation in approach to primary mode of anesthesia", "perspectives of patient preferences", and "importance of multidisciplinary team care". These findings led to the development of a decision aid provided as part of this paper, which may assist clinicians in counseling women on their options for care to come to an informed decision. Conclusions: Approach to anesthesia for PAS varied between healthcare providers. The final decision for anesthesia should take into consideration the clinical care needs as well as the preferences of the patient. Synopsis: Healthcare providers have varying approaches and preferences for anesthesia care in placenta accreta spectrum. [ABSTRACT FROM AUTHOR]

There is significant variation in practice when managing couples with recurrent miscarriage (RM), with guidelines differing on the definition of RM, recommended investigations, and treatment options. In the absence of evidence‐based guidance, and following on from a paper by the authors—FIGO Good Practice Recommendations on the use of progesterone in the management of recurrent first‐trimester miscarriage—this narrative review aims to propose a global holistic approach. We present graded recommendations based on best available evidence. Synopsis: Best practice recommendations for managing couples with recurrent miscarriage. [ABSTRACT FROM AUTHOR]

This award has been established for the purpose of encouraging investigators, especially young scientists, from low- and middle-income countries to submit their very best clinical research articles for publication in IJGO. The editors of the I International Journal of Gynecology and Obstetrics i (IJGO) are pleased to announce a prize award for the best clinical research paper from a low- or middle-income country published in the IJGO during 2021. IJGO is the official publication of the International Federation of Gynecology and Obstetrics (FIGO), the primary international organization for the specialty of obstetrics and gynecology. [Extracted from the article]

In April 2023, the World Health Organization (WHO) issued new estimates affirming that one in six individuals experience infertility globally. Yet, many states are unclear on their responsibility to prevent infertility, ensure access to treatment, and to end the harm suffered by individuals who are considered infertile. Responding to this uncertainty, in June 2023, the United Nations Office of the High Commissioner on Human Rights (OHCHR) issued a new research paper explaining states' legal obligations regarding infertility. Importantly, OHCHR underscores that states must take steps to prevent infertility by addressing its root causes and ensure access to treatment. Further, states must address the negative consequences of infertility, including stigma and violence, as well as the discriminatory stereotypes that lead to certain groups facing disproportionate harm from infertility. This article provides an overview of the OHCHR report and explains what this means for healthcare providers, who have a critical role to play in providing care and advocating for legal and policy reform necessary to prevent, diagnose, and treat infertility. Synopsis: This article provides an overview of OHCHR's new 2023 research paper on human rights obligations to address the preventable causes and consequences of infertility, and highlights healthcare providers' role in advancing human rights and preventing harm to patients through infertility prevention, diagnosis and treatment. [ABSTRACT FROM AUTHOR]

This article describes how Russian drug policy defies international ethical standards in patient care and violates the human rights of pregnant people who use drugs. While the CEDAW Committee previously found Russia to be in violation of the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) by failing to ensure that pregnant people have access to gender‐sensitive drug dependence treatment, to date the Committee has refused to address the role of drug criminalization in enabling this human rights violation. This article outlines the gendered impacts of Russia's punitive approach to drug use, including its detrimental effects on maternal health, and concludes by urging the CEDAW Committee to follow the approach of the UN Committee on Economic, Social and Cultural Rights, the UN Chief Executives, the World Health Organization, and UNAIDS, as well as senior UN lawyers and international legal experts to assess drug criminalization critically through the prism of the CEDAW convention. Synopsis: This paper assesses how Russia's punitive drug policy defies international ethical standards in patient care and violates the human rights of pregnant people who use drugs. [ABSTRACT FROM AUTHOR]

The International Journal of Gynecology & Obstetrics (IJGO) is celebrating its 60th year of publication in 2023. To commemorate this milestone, the journal has invited former and current editors to share their experiences and has compiled a special collection of influential papers from the past 60 years, which are available for free access for a limited time. The journal has a long history, starting in 1963 as a quarterly publication with a focus on attracting high-quality submissions and securing funding. Over the years, it has expanded its international reach, increased its publication frequency, and implemented important policies to promote diversity and equity in authorship. The journal has played a significant role in disseminating research on women's health, including during the COVID-19 pandemic. It remains committed to its global perspective and supporting authors and researchers, particularly those from low- and middle-income countries. The International Journal of Gynecology & Obstetrics (IJGO) is highly regarded worldwide through collaborations with expert committees and partnerships with organizations like the World Association for Trainees in Obstetrics and Gynecology. The journal is dedicated to promoting diversity and inclusivity by expanding its Editorial Board and amplifying the voices of researchers from low- and middle-income countries. It also advocates for women's rights and comprehensive reproductive healthcare. Under the leadership of Editor-in-Chief Michael Geary, IJGO aims to broaden its readership, increase its impact factor, and publish more open access articles. The journal is actively addressing research [Extracted from the article]

Objective: The United Nations' Sustainable Development Goal 3.7.1 addresses the importance of family planning. The objective of this paper is to provide information on family planning to policymakers to help increase access to contraceptive methods to women in sub‐Saharan Africa. Methods: We analyzed data from the Population‐based HIV Impact Assessment studies conducted in 11 sub‐Saharan African countries from 2015 to 2018 to assess the relationship between HIV services and family planning. Analyses were restricted to women aged 15–49 years who reported being sexually active within the past 12 months and had data on contraceptive use. Results: Approximately 46.4% of participants reported using any form of contraception; 93.6% of whom used modern contraceptives. Women with a positive HIV status were more likely to use contraceptives (P < 0.0001) than HIV‐negative women. Unmet need was higher among women who were confirmed to be HIV‐negative in Namibia, Uganda, and Zambia than confirmed to be positive. Women aged 15–19 years used contraception less than 40% of the time. Conclusion: This analysis highlights crucial gaps in progress among HIV‐negative and young women (aged 15–19 years). To provide access to modern contraception for all women, programs and governments need to focus on women who desire but do not have access to these family planning resources. Synopsis: Women who were HIV‐negative and were aged 15–19 years were less likely to use and had a higher unmet need for contraceptives. [ABSTRACT FROM AUTHOR]

At the start of the 20th century, cesarean section (CS) was uncommon in obstetrics. By the end of the century, CS rates had increased dramatically worldwide. Although the explanation for the increase is multifactorial, a major driver in the ongoing escalation is the increase in women who are delivered by repeat CS. This is due, in part, to the fact that there has been a sharp fall in vaginal birth after CS (VBAC) rates as fewer women are offered a trial of labor after CS (TOLAC), due principally to fears of a catastrophic intrapartum uterine rupture. This paper reviewed international VBAC policies and trends. A number of themes emerged. The risk of intrapartum rupture and its associated complications is low and may sometimes be overestimated. Individual maternity hospitals in both developed and developing countries are inadequately resourced to safely supervise a TOLAC. Efforts to mitigate the risks of TOLAC by careful patient selection and good clinical practices may be underutilized. Given the serious short‐term and long‐term consequences of rising CS rates for women and for maternity services generally, a review of TOLAC policies worldwide should be prioritized and consideration given to convening a Global Consensus Development Conference on Delivery after CS. Synopsis: The dramatic fall in trial of labor after cesarean section rates globally may reflect overestimation of risks and underestimation of benefits associated with vaginal birth. [ABSTRACT FROM AUTHOR]